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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1745197

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Case Details

VAERS ID: 1745197 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-09-29
Onset:2021-09-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3592 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Product preparation issue
SMQs:, Medication errors (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: asprin calcium 500mg Chromium-FTF 200 mcg Magnesium 200mg Multi Vitamin Sulfamethoxazole 800mg-trimethoprim 160mg Vitamin D
Current Illness: N/a
Preexisting Conditions: prediabetes osteopenia osteoarthritis
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: At this state there have not been any adverse outcomes. We administered the vaccine incorrectly. The patient received her 3rd Pfizer vaccine without the diluent and received 0.5ml rather than the 0.3mls.


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